Nigel HackingA new non-surgical treatment for enlarged prostate first performed in the UK at Southampton’s university hospitals is set to be offered to patients nationwide.
NICE – the National Institute for Health and Care Excellence – has updated its guidance for using Prostate Artery Embolisation (PAE) as a treatment for benign prostatic hyperplasia following a study led by specialists at University Hospital Southampton NHS Foundation Trust.
The innovative technique involves using a tiny plastic catheter inserted in the groin to place particles the size of grains of sand into the prostate arteries to cut the blood supply and shrink the gland.
The condition forces the prostate to expand onto the urethra – the tube connecting the bladder to the penis – and causes sufferers difficulty in starting urination, a frequent need to urinate and an inability to empty the bladder.
The problem affects around 60% of men over 60 and is usually treated with medication and lifestyle changes or, if these are unsuccessful, invasive surgery, which carries the possibility of side effects including retrograde ejaculation, infertility and incontinence lasting up to eight weeks and occasionally longer.
Dr Nigel Hacking and Dr Tim Bryant, consultant interventional radiologists at Southampton General Hospital, were the first in the UK to start the treatment in the UK in 2012 and began a study in 2015 to compare results of PAE with conventional surgery via a registry of prostate embolisation known as UK-ROPE.
A total of 18 centres in the UK recruited more than 200 PAE patients over the period of two years and compared these with 100 men having more conventional surgical options, mainly transurethral resection of the prostate (TURP).
“The UK-ROPE project has taken several years and required extra training of professionals working in 18 centres across England and Scotland,” said Dr Hacking, who helped to develop a similar method to PAE to shrink fibroids in women known as uterine fibroid embolisation (UFE).
“Results from the study show PAE can help large numbers of men suffering with the symptoms of an enlarged prostate. It is a particularly good option for men who are not yet ready to undergo more invasive prostate surgery.
“The fact that this is a day case procedure with no need for a urinary catheter or a general anaesthetic coupled with maintaining sexual function and fertility are some of its attractions to many men.
“I hope with NICE’s recommendations released today that more centres will be able to introduce PAE services in the not too distant future.”
Rob Baxter, a patient who has undergone the PAE procedure at Southampton General, said: “I have suffered from an enlarged prostate for a number of years. Inconvenient loo visits were ruining my life. I couldn’t enjoy a meal with my partner, watch a rugby game with friends or even go for a run without ensuring there was a toilet nearby.
“Undergoing PAE has improved my condition enormously, to the point where I hardly notice any significant issues now. Last weekend I ran my fifth London Marathon in 4 hours 59 minutes and stopped just once. This would have been impossible 12 months ago. All in all, a very happy patient.”
Professor Kevin Harris, clinical director for the NICE interventional procedures programme, added: “This is an excellent example of what can be achieved when we work together effectively across the system. NICE flagged the need for more evidence and that is exactly what we have received. The availability of this procedure could make a real difference to the lives of men up and down the country.”
Posted on Wednesday 25 April 2018